Permit (7) Ilk �,� CITY OF TIGARD PLUMBING PERMIT
I '_-, COMMUNITY DEVELOPMENT Permit#: PLM2016 00474
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/13/2016
Parcel: 1S134DA04800
Jurisdiction: Tigard
Site address: 11385 SW 108TH AVE
Project: Briggs Subdivision: DOREEN COURT Lot: 5
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: JM IRRIGATION DESIGN LLC Owner: BRIGGS,JOSEPH R&MICHELLE L
1235 ALETHA ST 11385 SW 108TH AVE
WOODBURN, OR 97071 TIGARD, OR 97223
PHONE: 971-246-2327 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/13/2016 $31.27
Specifics:, 1 12%State Surcharge- 09/13/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 09/13/2016 $41.23
Class of Work: OTR Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No' ' •. Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ay obtain a copy of the rules
or d' ct questions to a UNC • ailing 503.232.1987 or 1.800.332.2344.
I
Cabo
0._ / / Permittee Signature: /-
Lei
,/
Iliffr
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
City of Tigard H°-r-< .; t Received9 /
III IIII 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �3 I5� Permit PLM to_00q7 y7
U Phone: 503.718.2439 Fax: 503.598.19_P1 2016 Date/Plan
geviewy; Other Permit No.:
I I c A R n Inspection Line: 503 639.4175
Date Ready/By
Juns
Internet: wwwti and oov A s ,y y „' y Notified/Method:
Supplemental Informa
hon
, , @W , it: ' ,..7: a .,::* . - sue � � .
t,
0 New construction ❑Demolition For special information use checklist
❑Addition/alteration/replacement 12'0ther: Description I Qty. I Ea. I Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
4 0. '. a ! 4 , : SFR 1 bath
.
t O 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
r.iflfFes„ ., Ym hi; `,E „,, ,a. * ,: Site utilities:
Job site address: 1 1 j 1 1, Catch basin or area drain 18.76
City/State/ZIP: v Drywell,leach line,or trench drain 18.76
1Z Z2 VFooting drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes
18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.:
Fixture or item:
Tax map/parcel no Backflow preventer / 31.27
I ., s . ..r `. tJ ,ti:IW, l }. 7, 'y &...„ Backwater valve 12.51
_ Clothes washer
-0DU< 1.Lwtk) pg. y t;),) � IZ 25.02
`�J Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.''s*, `,� :.. . . 3rx . . z Expansion tank 12.51
0 P (,l-- 431216, ,4_5Fixture/sewer cap 25.02
y
Name: t' Y I I(-
Address: 1 r 395 L•, ,,,u /0)6 i k Floor drain/floor sink hub 25.02
l Garbage disposal 25.02
City/State/ZIP: "\1 �\--f) OV-- 9 '7 Z
Hose bib 25.02
Phone:( ) Fax
( ) Ice maker
7%,:,;', 5,70::y t 7e T ` '� -° � 12.51
.. . ..� ,r ,..., t As,. r , 1� Interceptor/grease trap 25.02
Business name:t 'l 1 .1c). \---7-‘'-) k.0j� 0 e i c Medical gas(value:$ ) Page 2
Contact name: 1 �J Primer 12.51
� v,N�( �Qt�� LLIA
_ Roof drain(commercial) 12.51
Address: / Z 3.5 t L ( 4-S( 5
Sink/basin/lavatory 25.02
City/State/ZIP: LA)OQ 0 [3.42 017(r G�'j6 / Solar units
7 (potable water) 62.54
Phone:(I Z f ) %L(!, ---,73 Z i Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
2 , €. ms i tl �'ry fs r- aa� . ro Water closet 25.02
Business name: j ( C6. /' 0 ')/K✓E7 2_p t
Water heater 37.52
„J �1.. Waterpiping/DWV 56.29
Address: t23 E r\»
Other: 25.02
City/State/ZIP: WO f) Du / r Cie G 707/ Subtotal
Phone:(�'�l') 2:--7 Fax:( ) Minimum permit fee: $72.50 7a.Sa
CCB Lic.: c-.-'-7 ///14,44, Plumbing Lic.no.: Plan review (25%of permit fee)
Authorized signature: ,��� State surcharge(12%of permit fee) 8,70
t` ��� TOTAL PERMIT FEE U l
Print name: t1 • i Si N(( L Date: This permit application expires if a permit is not obtained within 180 days
T after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:A Building APermits\PLMU-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sunoression S stems:
Footing drain-1'1100' 50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100'
37.52 V ti ''',0,0w*";", 4 .:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
a Wirt f each additional$100.00 or fraction thereof,to
. d € and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr ■ each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business - 90.00/hr - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum char:e-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr _ and including$50,000.00.
Additional plan review for revisions - 90.00/hr $50,001.00 and up each additional742.00 for the first0 .0$50,000.00 ofraction and ere,1.20 for
each $100.00 or thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. 1, � ` 1 310. '41t w ' ! ` a #
`'quantttyb} f tur Tv e Plan review is required for any of the following.
Fixture"Type for" ,,,,< Iteplat Please check all that apply.
Capped Added Rr ovate 0 Any new commercial building with water service 2"and
WkPrfortue�. ,. � ... -� w �,n.� -
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Cormnercial ❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" `
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
• -Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2